Building a Telemedicine Network in the Sunshine State

Florida’s teletrauma pilot helps create a network of specialists available to the most remote of patients.

Jessica Mulholland is the associate editor of GOVERNING, and is also the associate editor of both Government Technology and Public CIO magazines.

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When someone is injured in Key West, Fla., emergency personnel can bring trauma specialists 130 miles away in Miami straight to the scene -- virtually.

As part of a pilot, emergency room personnel at the Lower Keys Medical Center in Key West and specialists at Miami’s Ryder Trauma Center each have a mobile cart complete with a laptop, a high-definition video camera and wireless Internet capabilities. The open laptop allows Lower Keys emergency room staff to speak to Dr. Antonio Marttos, director of trauma telemedicine at University of Miami Miller School of Medicine, and other trauma specialists who can help determine if the patient can be treated in Key West or needs a costly, hour-long helicopter ride to Miami.

If treatment at the scene will suffice, Lower Keys staffers can use the camera to provide a visual of the injuries that need immediate treatment and receive advice from a Ryder trauma surgeon. If the helicopter ride is vital, the rural hospital can then stabilize the patient for transport. “I think it’s an excellent resource in an area where we cannot provide every specific specialty that a patient could need,” says Sandy Rodriguez, emergency department manager at Lower Keys Medical Center.

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One of the telemedicine program’s goals is to strengthen disaster response in case of a public health incidence. Since staffers at the partner hospitals use this technology every day, says Marttos, "if they have a disaster, it should be as easy to use this equipment as it is to make a phone call."

This telemedicine infrastructure and equipment proved its worth in 2010 when Miami doctors treated victims of the Haiti earthquake remotely. Doctors in Miami and in Haiti evaluated and treated approximately 250 critically ill patients within 48 hours, says Susan McDevitt, director of the Office of Trauma for the Florida Department of Health, adding that the trauma team in Miami also conducted radiology, pediatric neurosurgery and nephrology consults remotely, and read ultrasounds via machines at the patient’s bedside.

The initial cost for trauma centers and rural hospitals to set up the network and peripherals can go up to $135,000, with about $20,000 to $25,000 needed yearly to sustain the program, McDevitt says. All funding for the pilot has come from U.S. Department of Health and Human Services grants that are earmarked for disaster preparedness measures, says Jean Kline, director of the Division of Emergency Medical Operations at the Florida Department of Health. In addition to Ryder, the pilot has since expanded to six other trauma centers (and its partner rural hospitals) across the state. The plan is to add one additional trauma center and its corresponding rural hospital next year, says Kline.

Marttos says that there was one challenge to overcome in creating this telemedicine network: how to secure the information being transferred. “All these calls needed to be encrypted. We had to work with the firewall to make sure we had the maximum security for patients,” Marttos says. “The only people who are going to see the information are the physician who has the patient and the physician who’s going to receive the patient,” ensuring that the information exchange is secure and HIPAA compliant.

For Marttos, the telemedicine network should be maintained and expanded. “It’s the kind of situation where, once you have a cell phone, you always want to have a cell phone. Once you have Internet, you always want to have the Internet,” he says. “They’re not toys – we’re used to them. We need them.”

Many states are embracing telemedicine by encouraging it in their Medicaid programs and requiring private insurers to pay for it. But doctors still have to get separate licences to give medical consultation in different states.
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